tbuckley/cabot-search huggingface dataset:
Characteristics of lung cancer in renal transplant recipients.
Authors: Arthi Sridhar, Binoy Yohannan, Harmanpreet Kaur
Journal: Journal of Clinical Oncology (2023)

e20592 Background: Renal transplant recipients (RTRs) are at a higher risk of developing malignancies primarily due to prolonged immunosuppression. Lung cancer while rare in RTR, is associated with significant morbidity and mortality. The primary objective of our study is to analyze the clinical characteristics and outcomes of RTRs who developed lung cancer at our institution. Methods: We retrospectively reviewed 1998 RTRs who underwent transplantation between January 1, 1999, and December 31, 2019, at our institution and identified patients who were diagnosed with lung cancer after transplant. Baseline demographic variables and information related to the renal transplant, the diagnosis and management of lung cancer were collected. Results: Among 1998 RTRs, 10 patients (0.005%) developed lung cancer. A majority of the lung cancer patients identified as male (n = 8), and the median age was 62.5 years. The races of the patients were white (30%, n = 3), African American (50%, n = 5), Hispanic (10%, n = 1), and Native American (10%, n = 1). Concomitant liver transplant was performed in 2 patients, and a concomitant heart transplant was performed in 1 patient. Median time to lung cancer diagnosis after transplant was 67.5 months (range, 12-168). The histology of the lung cancers found were adenocarcinoma (n = 4), squamous (n = 4), and small cell (n = 2). All patients had a history of smoking, with 90% reporting a &gt; 15 pack-year history of smoking and none of them received lung cancer screening. Among the patients with non-small cell lung cancer (NSCLC), 87.5% (n = 7) had early-stage disease, and 12.5% (n = 1) had locally advanced disease (Stage IIIB). Both patients diagnosed with small cell lung cancer had extensive-stage (es-SCLC) disease at the time of diagnosis. Among patients with NSCLC, 2 had genomic tumor profiling performed. Among patients with early-stage NSCLC, 57% underwent upfront surgery, 14% received radiation alone, 14% received neoadjuvant chemotherapy, and 14% received adjuvant chemotherapy. Around 71% (n = 5) remained alive at the last follow up recorded. The patient with stage IIIB NSCLC received chemotherapy and concomitant radiation but had an overall survival (OS) of only 6 months; that patient died of complications related to cancer progression. Both patients with es-SCLC received front-line chemotherapy with carboplatin and etoposide. To our knowledge, 40% (n = 4) of these patients retained their renal graft function. At 1-year from diagnosis, 40% of patients diagnosed with lung cancer were still alive. Conclusions: Lung cancer in RTRs is rare but is associated with significant morbidity and mortality. With the improving life expectancy of RTRs, the incidence of de novo malignancies including lung cancer is likely to increase. Annual screening for lung cancer in high-risk individuals is an important step for early diagnosis. Surgical resection and chemotherapy are well tolerated in patients with lung cancer.
Evaluating response to interventions for vasomotor symptoms in patients with breast cancer: A patient-centered approach.
Authors: Katherine Cole, Sharon McGee, Mark J. Clemons, Michelle Liu, Fiona MacDonald, Lisa Vandermeer, Terry L. Ng, Gregory Russell Pond, Khaled El Emam
Journal: Journal of Clinical Oncology (2023)

e24126 Background: Vasomotor symptoms (VMS), such as hot flashes, are a common reason for early discontinuation of endocrine therapy for patients (pts) with breast cancer (BC). The optimal intervention for VMS remains unknown. Using a novel symptom change analysis and regression trees, we examined whether clinically important change in VMS severity depends on baseline symptomatology. Methods: In this prospective study, pts with BC experiencing VMS chose either a lifestyle (LS), or non-LS (i.e. complementary and alternative therapies [CAM], prescription medications [PM], or endocrine therapy modification [ETM]) intervention. The primary outcome was change in symptom severity using the 10-point Hot Flush Rating Scale (HFRS). Patients declining interventions were included as controls. At the end of the 6-week intervention, participants rated the effectiveness of their chosen intervention on a five-point Likert scale. A logistic sigmoid function and Bayesian optimization were used to weight the change in VMS score based on baseline VMS severity. A regression tree was trained to predict which intervention resulted in the greatest improvement in VMS at 6 weeks. Results: 100 baseline and follow-up questionnaires from 85 pts were included in an intention to treat analysis. The median baseline HFRS was 5.0 (IQR 3.33 ,7.00). Selected interventions included LS (27%), CAM (25%), PM (11%) and ETM (8%), with 29% declining interventions. After removal of missing data, 59 individuals provided responses for both the HFRS score and the effectiveness score. Higher baseline HFRS scores had greater impact on symptom change scores. The largest difference in VMS improvement was noted between the non-LS (median symptom change –0.82, IQR –2.00, –0.01) and LS/control groups (median symptom change – 0.38, IQR –1.46, 0.00) (Table 1). Of non-LS interventions, CAM had the greatest improvement in VMS severity. Pre-menopausal individuals who pursued LS interventions had the least improvement in VMS severity. Conclusions: Interventions for VMS were most impactful among pts with greater baseline symptoms. While LS interventions were the most commonly selected intervention, the resulting improvement in symptoms at 6 weeks was negligible, and alternative strategies should be encouraged. Future studies integrating pt preferences and accounting for baseline symptom severity are needed. [Table: see text]
Lung cancer screening status and acceptability of a personalized approach in Texas.
Authors: Paul Resong, Jiangong Niu, Gabrielle Duhon, Lewis E. Foxhall, Sanjay Shete, Robert Joseph Volk, Iakovos Toumazis
Journal: Journal of Clinical Oncology (2023)

e22516 Background: Current lung cancer screening (LCS) guidelines rely on age and smoking history. Despite its proven benefit, only 5-15% of eligible patients receive LCS, with Texas having one of the lowest rates among states in the US. Personalized screening strategies select people for LCS based on their personal lung cancer risk and may increase LCS’s effectiveness and efficiency. We assess current LCS practices and the acceptability of personalized LCS among primary care providers (PCP) in Texas. Methods: We surveyed 32,983 Texas-based PCPs including primary care physicians, physician assistants, and nurse practitioners on an existing network (Protocol 2019-1257; PI: Dr. Shete), and 400 attendees of the 2022 Texas Academy of Family Physicians (TAFP) conference. Deidentified demographics, current LCS practices, and acceptability of personalized LCS were obtained. We analyzed the responses by subgroups of interest using comparative statistics. Using nonparametric bootstrap, we derived an enriched dataset and utilized it to develop logistic regression models to further understand respondent tendencies related to current LCS practices and acceptability of personalized LCS. Results: Response rates were 0.3% (n=91) and 15% (n=60) for the 2019-1257 and TAFP surveys, respectively. Respondent demographics are provided in the table. Most (84%) respondents regularly assess LCS in their practice, with those in the following categories more likely to assess for LCS eligibility: 40-49 years old, female, non-Black, physicians, with &lt;10 years in practice, seeing &gt;50 patients per week, and work at a non-residency training site (all p-values &lt; 0.05). Half of the respondents were interested in adopting personalized LCS while an additional 40% wanted to learn more information. Respondents in the following categories were associated with increased interest in personalized LCS: younger than 60 years, non-White, non-physicians, seeing 100 or more patients per week, at a non-residency training site, and at a decentralized practice (all p values &lt; 0.05). Majority (66%) of respondents expressed concerns regarding time availability with the personalized LCS. Conclusions: There is a great need to enhance the awareness and engagement of Texas-based PCPs about LCS. Most of the respondents expressed interest in personalized LCS. Time availability was the main concern related to personalized LCS. Findings from this project highlight the need for better education of Texas-based PCPs on the benefits of LCS, and the development of efficient decision tools to facilitate shared decision-making sessions to ensure successful implementation of personalized LCS. [Table: see text]
Cost-effectiveness analyses of population-based multi-gene testing for the prevention of breast and ovarian cancer in the United States.
Authors: Fangjian Guo, Victor Adekanmbi, Ya-Chen Tina Shih, Abbey Berenson, Yong-Fang Kuo
Journal: Journal of Clinical Oncology (2023)

10596 Background: The current method of testing for BRCA gene mutations, which is based on family history, often fails to identify many carriers. With the advancement of next-generation sequencing technologies, which have significantly lowered the cost of genetic testing and sequencing, population-based testing has been proposed. We evaluated the cost-effectiveness of population-based multi-gene testing as a means of preventing breast and ovarian cancer. Methods: We developed a microsimulation model to assess the cost-effectiveness of multi-gene testing (BRCA1/BRCA2/PALB2) for all women aged 30-35 years compared to the current standard of care that is family history-based. We selected these genes for analyses as they are most prevalent high penetrance genes. We assumed a test uptake rate of 70%. Carriers of pathogenic variants who were not affected by cancer were offered interventions, such as MRI/mammography, chemoprevention, or risk-reducing mastectomy and risk-reducing salpingo-ophorectomy (RRSO), to reduce the risk of breast and ovarian cancer. We incorporated excess coronary heart disease (CHD) deaths from premenopausal RRSO. Our main outcome measure was the incremental cost-effectiveness ratio (ICER)(i.e., cost per-quality-adjusted life year (QALY) gained), with the commonly used societal willingness to pay of $100,000/QALY in the US as the C-E threshold. We ran 500 simulations on 1,000,000 women, employing a lifetime time horizon and payer perspective, and adjusted the cost to 2022 US dollar. We also used probabilistic sensitivity analyses to evaluate model uncertainty. Results: In the base case, population-based multi-gene testing is more cost-effective compared to family-history based testing, with an ICER of $41,306/QALY (95%CI $35,630-$48,441/QALY). This new testing method is able to prevent an additional 1,369 cases of breast cancer and 807 cases of ovarian cancer, but it will also result in 8 excess heart-disease deaths per million women. The probabilistic sensitivity analyses show that the probability that population-based multi-gene testing is cost-effective is 100% for all the simulations. When the cost of the test exceeds $1,100 population-based multi-gene testing becomes economically inefficient (ICER $10,0886/QALY). Conclusions: Population-based multi-gene testing is a more cost-effective option for the prevention of breast cancer and ovarian cancer when compared to current family-history-based testing methods.
A retrospective chart review of palliative care consultation during curative-intent chemoradiation for head and neck cancer.
Authors: Farsha Rizwan, Christopher Davella, Madeline Albert, Traci King, Brian L. Egleston, Thomas James Galloway, Marcin Chwistek, Carolyn Y Fang, Areej El-Jawahri, Jessica R Bauman
Journal: Journal of Clinical Oncology (2023)

e24165 Background: Head and neck cancer (HNC) treatment with chemoradiation therapy (CRT) is highly morbid. Patients develop significant symptoms including severe pain, dysphagia, and malnutrition resulting in poor quality of life (QOL), frequent hospitalizations, and high rates of depression. Although integration of palliative care (PC) teams into the care of incurable cancers has resulted in improved QOL, less is known about its integration into the care of patients receiving curative-intent treatments. We sought to characterize the use of PC during HNC CRT at a single cancer center. Methods: We performed a retrospective chart review of patients who received curative-intent CRT for HNC from 1/2008 to 1/2019 at Fox Chase Cancer Center. We excluded patients with metastatic disease or who participated in a PC intervention study. Data extracted included: demographics, comorbidities, cancer subtypes, human papilloma virus (HPV) status, inpatient admissions, feeding tube use, pain medication usage, and PC referrals throughout CRT. We used parametric and non-parametric statistics for hypothesis testing. Results: A total of 332 patients were included; median age was 60, 73% were male, 57.8% had oropharynx HNC, 10.2% had a history of chronic pain, and 18.9% had a psychiatric diagnosis. At the start of treatment, 38.5% of patients were on opioids for cancer pain or chronic pain, which increased to 90.7% of patients by the end of CRT. Six months after CRT, 30% of patients remained on opioids. 44.7% of patients required a feeding tube and 51.4% were admitted to the hospital. Despite the significant symptomatology, only 64 patients (19.2%) were referred to PC during treatment. The patients referred to PC were more likely to be younger (p=0.002), have an inpatient admission during treatment (p=0.001), a history of a psychiatric disorder (p=0.001) or substance abuse (p=0.003), and less likely to have HPV-related HNC. Conclusions: A large majority of patients receiving CRT for HNC faced significant pain with a high hospitalization rate, yet few had the expertise of PC involved in their care. Those who were referred to PC were more likely to have pre-existing substance use or chronic pain. These data provide strong rationale for the development of standardized, PC-based interventions to help with the symptomatology of HNC treatment to better serve this high needs population. [Table: see text]
Impact of exercise on chemotherapy-induced peripheral neuropathy (CIPN) in survivors with post-treatment primary breast cancer.
Authors: Kirin Saint, Alexie Lessing, David Nemirovsky, Yuan Chen, Whitney P. Underwood, Mary Lou Galantino, Lee Jones, Ting Bao
Journal: Journal of Clinical Oncology (2023)

12077 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of neurotoxic chemotherapy with limited treatment options. We examined the association between exercise and CIPN symptoms in patients with post-treatment primary breast cancer. Methods: Using a retrospective design, patients completing a standardized survey assessing exercise exposure, neuropathy symptoms, and pain in a tertiary cancer center survivorship clinic were included. Exercise was assessed using a standardized questionnaire quantified in standardized metabolic equivalent tasks (MET-h/wk). Chi-square tests, Mann-Whitney U-tests, Kendall’s rank correlations, and multivariable logistic regressions adjusting for important clinical covariates examined the relationship between exercise and CIPN and whether this differed as a function of chemotherapy regimen (taxane vs. non-taxane based therapy). Results: A total of 5,444 patients with primary breast cancer previously treated with adjuvant chemotherapy (median age 62 years (IQR: 55, 71); median of 4.7 years post chemotherapy completion (IQR: 3.3, 7.6)) were identified. The overall prevalence of CIPN was 34% (95% CI: 33%, 36%); 33% (95% CI: 31%, 34%) for non-taxane and 37% (95% CI: 35%, 39%) for taxane based chemotherapy. The prevalence of CIPN was 28% (95% CI: 26%, 30%) among exercisers (≥5 days of moderate or ≥3 days of strenuous exercise per week) and 38% (95% CI: 37%, 40%) among non-exercisers (difference 11%; 95% CI: 8%, 13%; p &lt; 0.001). Associations appeared dose-dependent. CIPN prevalence was 42% for &lt; 6 MET-h/wk, 33% for 6-20.24 MET-h/wk and 29% for &gt; 20.25 MET-h/wk (p-value &lt; 0.001). Exercise was associated with reduced prevalence of all individual CIPN symptoms (numbness and tingling, pain, interference in daily living). Higher exercise was associated with lower CIPN regardless of chemotherapy regimen. Conclusions: CIPN is persistent several years following chemotherapy cessation in patients with breast cancer but significantly reduced by exercise in a dose-dependent manner.
Patient characteristics and treatment patterns in BRAF-mutated unresectable or metastatic melanoma in the United States: A snapshot from real-world data.
Authors: Laura Mesana, Kristina Chen, Benjamin Li, Nana Rezai, Sina Noshad, Yajin Zhao, Anup Abraham
Journal: Journal of Clinical Oncology (2023)

e21506 Background: BRAF mutations are found in 40-60% of patients with unresectable/metastatic melanoma (m-melanoma). Recently, several new BRAF-targeted therapies (TT) have been approved, transforming the treatment landscape for patients with BRAF-mutated (BRAFm) unresectable/m-melanoma. This analysis aimed to describe patient characteristics and treatment patterns in BRAFm unresectable/m-melanoma patients receiving treatment during November 2015-June 2021. Methods: A retrospective analysis using Flatiron Health’s database was conducted. Adult patients with unresectable/m-melanoma who had evidence of the BRAF-V600 activating mutation were included. Patients were indexed at first-line (1L) therapy initiation. Treatments of interest were classified into immuno-oncology (IO) therapies and TT. All analyses were descriptive. Results: 671 unresectable/m-melanoma patients (average age: 62.7 years, 64.1% male) were included. Among them, 64.4% of patients received IO, 34.4% received TT, and 1.2% received IO+TT. In 1L, ipilimumab+nivolumab and dabrafenib+trametinib were the most common IO (50.9%) and TT (71.9%), respectively. The median duration of 1L was 8.0 months (9.7 months in IO and 6.7 months in TT). Among IO-treated patients, 28.5% had Eastern Cooperative Oncology Group (ECOG)≥1, 23.4% had elevated lactate dehydrogenase (LDH) levels, and 4.9% had 3+ metastases identified. Among TT-treated patients, 42.9% had ECOG≥1, 27.3% had elevated LDH, and 7.8% had 3+ metastases identified. Approximately one-third of the patients (n = 204) received their 1L treatment prior to being tested for BRAF mutation; the majority of whom (90.2%) received IO. 273 patients (40.7%) advanced to a second line (2L). In 2L, 14.3% of patients received the same class of therapy as in 1L, 44.7% switched from 1L IO to 2L TT, and 35.2% switched from 1L TT to 2L IO. In 2L, ipilimumab+nivolumab (50.0%) in IO and dabrafenib+trametinib (60.7%) in TT were the most common combinations. The median duration of 2L was 5.0 months (3.7 months in IO and 6.5 months in TT). Conclusions: Despite the recent availability of TT combinations for BRAFm unresectable/m-melanoma, IO is about twice as frequently prescribed than TT in 1L. One-third of the patients received treatment before BRAFm testing results were available and most of them were prescribed IO. These findings along with elevated ECOG scores, the proportion of 3+ metastases, and elevated LDH levels seen in TT patients, suggest TT is often offered to patients with a high disease burden in the current practice settings.
Efficacy of eribulin administered in combination with an immune checkpoint inhibitor (ICI) and anlotinib as salvage treatment for patients (pts) with advanced adult soft tissue sarcoma (STS).
Authors: Xi Guo, Yuhong Zhou, Rongyuan Zhuang, Chenlu Zhang, Yang You, Wei Li, Zhiming Wang
Journal: Journal of Clinical Oncology (2023)

11572 Background: Eribulin combined with a multi-targeted antiangiogenic tyrosine kinase inhibitor has shown efficacy in STS. ICIs have also exhibited improved survival in some STS subtypes. We investigated the efficacy and safety of triple combination therapy with eribulin, an ICI and anlotinib in the treatment of advanced STS in an adult Chinese population. Methods: This study retrospectively analyzed data from patients diagnosed with advanced STS who received combination therapy with eribulin, an ICI and anlotinib at the Department of Oncology, Zhongshan Hospital affiliated to Fudan University. The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate (ORR) by RECIST v1.1, disease control rate (DCR), and treatment-related adverse events (TRAEs) by CTCAE v5.0. Results: Medical records from 32 pts treated between August 15, 2020 and January 31, 2023 were included; the median age was 56 years, 71.8% (23/32) were female, 75.0% (24/32) had an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1, and 25.0% (8/32) had an ECOG PS of 2. Pts had received a median of 2 (range 0-6) prior regimens and the median follow-up was 4.1 months. Among the patients, 50.0% (16/32) had liposarcomas (including 1 with pleomorphic liposarcoma and 15 with dedifferentiated liposarcoma [DDLPS]), 31.3% (10/32) had leiomyosarcomas (LMS), 3 had undifferentiated pleomorphic sarcoma (UPS), and 1 each had angiosarcoma, rhabdomyosarcoma and desmoplastic small round cell tumor. In a preliminary analysis, 29 pts were evaluable for clinical activity; partial responses (PRs) were achieved in 3 pts (2 DDLPS, 1 UPS), the ORR and DCR were 10.3% (3/29) and 62.1% (18/29) respectively, and the median PFS was 5.7 months (95% CI 2.7-9.8). Of the 15 pts with DDLPS (median 1 prior line of therapy; median follow-up 6.3 months), 13 were evaluable for clinical activity; a PR was achieved by 15.4% (2/13), the DCR was 61.5% (8/13), the median PFS was 9.8 months (95% CI 1.8-28.5) and treatment was ongoing in 46.7% of pts (n = 7). Among the 9 evaluable pts with LMS, 0 achieved a PR, the DCR was 44.4% (4/9), median PFS was 3.9 months and 3 pts were still receiving treatment. In the overall cohort (n = 32), TRAEs of any grade occurred in 56.3% of pts (n = 18), the most common were myelosuppression (28.1%), fatigue (15.6%), fever (12.5%) and rash (12.5%). Grade 3/4 TRAEs occurred in 12.5% of pts, with no grade 5 events. Conclusions: This study demonstrates the potential efficacy of combination therapy with eribulin, an ICI and anlotinib in patients with advanced STS, especially in those with the DDLPS subtype. Our data suggest that this combination has good tolerability and a prospective trial is warranted. Clinical trial information: ChiCTR2100053594.